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Updated: Dec 16 2021


  • Snapshot
    • A 21-year-old male college student presents to the health clinic complaining of intense itchy, painful, red streaks between his fingers and in the groin area. The patient reports that the itchiness seems to be worse at night. Several other students have presented with similar problems over the last couple of weeks.
  • Introduction
    • Superficial skin infection caused by arthropod Sarcoptes scabiei (mite)
    • Severe itching at night
    • Too small to be seen by naked eye
    • Pathognomonic sign
      • burrows linear markings in skin due to mites’ movements
    • Risk factors
      • close contacts with scabies
  • Presentation
    • Symptoms
      • hallmark feature
        • itching worse at night
    • Physical exam
      • adults
        • burrows, especially in between finger web spaces
        • erythematous, inflamed pustules and papules
        • linear markings in skin with some scale
        • commonly on wrist, finger webs, axillae, chest, umbilicus, and genital area
      • children
        • generalized pruritic rash
        • scalp may also be involved
      • immunocompromised
        • commonly on scalp and head
        • extremely high mite burden
        • "crusty"
        • secondary bacterial infection
  • Evaluation
    • Diagnosis based on clinical exam and history
    • Diagnosis confirmed with simple office procedure
      • skin scraping with mineral oil prep
        • can see mites under microscopy
  • Differential
    • Chiggers
    • Bedbugs
      • live in old mattresses
      • painless bites with pruritic and purpuric macules
      • treatment is symptomatic (triamcinolone)
    • Contact dermatitis
  • Treatment
    • Topical permethrin
      • apply to entire body for 8-10 hours
      • repeat in one week
    • If extensive involvement (immunocompromised individuals)
      • oral ivermectin
    • Sterilize laundry
      • wash/dry all clothing with high heat or throw away
  • Prevention, and Complications
    • Prevention
      • avoid those with known scabies
      • treat all known contacts
      • sterilize laundry
    • Complications
      • secondary bacterial infections
  • Prognosis
    • Very good with treatment
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